|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
OP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Gatekeeper |
$39.52
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$48.45
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$31.35
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$42.75
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Cigna of CA HMO/PPO |
$37.05
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$48.45
|
| Rate for Payer: Dignity Health Medi-Cal |
$48.45
|
| Rate for Payer: Dignity Health Senior |
$48.45
|
| Rate for Payer: EPIC Health Plan Commercial |
$37.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$35.28
|
| Rate for Payer: Heritage Provider Network Senior |
$35.28
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$32.42
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$27.47
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$48.45
|
| Rate for Payer: Vantage Medical Group Senior |
$48.45
|
|
|
HC THRPTC INTVN 1ST 15 MIN ST
|
Facility
|
IP
|
$57.00
|
|
|
Service Code
|
CPT 97129
|
| Hospital Charge Code |
905107132
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$10.32 |
| Max. Negotiated Rate |
$42.75 |
| Rate for Payer: Adventist Health Commercial |
$11.40
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$39.16
|
| Rate for Payer: Cash Price |
$25.65
|
| Rate for Payer: Heritage Provider Network Commercial |
$38.59
|
| Rate for Payer: Heritage Provider Network Senior |
$38.59
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$10.32
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$14.25
|
| Rate for Payer: Multiplan Commercial |
$42.75
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Senior |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC THRPTC INTVN EA ADD 15MIN
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107130
|
|
Hospital Revenue Code
|
420
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC THRPTC INTVN EA ADD 15MIN OT
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107133
|
|
Hospital Revenue Code
|
430
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Senior |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$100.00
|
| Rate for Payer: TriValley Medical Group Senior |
$100.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
IP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$41.25 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$37.24
|
| Rate for Payer: Heritage Provider Network Senior |
$37.24
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
|
|
HC THRPTC INTVN EA ADD 15MIN ST
|
Facility
|
OP
|
$55.00
|
|
|
Service Code
|
CPT 97130
|
| Hospital Charge Code |
905107134
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$9.96 |
| Max. Negotiated Rate |
$343.00 |
| Rate for Payer: Adventist Health Commercial |
$11.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$38.33
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.78
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$46.75
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$30.25
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$41.25
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$306.00
|
| Rate for Payer: Blue Shield of California Commercial |
$343.00
|
| Rate for Payer: Blue Shield of California EPN |
$295.00
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cash Price |
$24.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.75
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$46.75
|
| Rate for Payer: Dignity Health Medi-Cal |
$46.75
|
| Rate for Payer: Dignity Health Senior |
$46.75
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.75
|
| Rate for Payer: Heritage Provider Network Commercial |
$34.04
|
| Rate for Payer: Heritage Provider Network Senior |
$34.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$30.95
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.51
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.96
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.75
|
| Rate for Payer: Multiplan Commercial |
$41.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$125.00
|
| Rate for Payer: TriValley Medical Group Senior |
$125.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$248.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$209.00
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$46.75
|
| Rate for Payer: Vantage Medical Group Senior |
$46.75
|
|
|
HC THRPTC SPNL PNCTR CSF FLUOR/CT
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
CPT 62329
|
| Hospital Charge Code |
909002329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.76 |
| Max. Negotiated Rate |
$3,517.28 |
| Rate for Payer: Adventist Health Commercial |
$347.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,194.69
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$864.04
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$3,517.28
|
| Rate for Payer: Blue Shield of California EPN |
$3,022.94
|
| Rate for Payer: Cash Price |
$782.55
|
| Rate for Payer: Cash Price |
$782.55
|
| Rate for Payer: Cash Price |
$782.55
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,130.35
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Dignity Health Medi-Cal |
$950.44
|
| Rate for Payer: Dignity Health Senior |
$864.04
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,043.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$864.04
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,076.44
|
| Rate for Payer: Heritage Provider Network Senior |
$1,062.77
|
| Rate for Payer: Humana Medicare |
$864.04
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$458.94
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$864.04
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,641.68
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.76
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,019.57
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,088.69
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,088.69
|
| Rate for Payer: Multiplan Commercial |
$1,304.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$950.44
|
| Rate for Payer: TriValley Medical Group Senior |
$950.44
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,296.06
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$950.44
|
| Rate for Payer: Vantage Medical Group Senior |
$864.04
|
|
|
HC THRPTC SPNL PNCTR CSF FLUOR/CT
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
CPT 62329
|
| Hospital Charge Code |
909002329
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$314.76 |
| Max. Negotiated Rate |
$1,304.25 |
| Rate for Payer: Adventist Health Commercial |
$347.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,194.69
|
| Rate for Payer: Cash Price |
$782.55
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,177.30
|
| Rate for Payer: Heritage Provider Network Senior |
$1,177.30
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.76
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.75
|
| Rate for Payer: Multiplan Commercial |
$1,304.25
|
|
|
HC THYROGEN 1.1MG
|
Facility
|
IP
|
$5,235.00
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
909301498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$947.54 |
| Max. Negotiated Rate |
$3,926.25 |
| Rate for Payer: Adventist Health Commercial |
$1,047.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,596.44
|
| Rate for Payer: Cash Price |
$2,355.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,408.10
|
| Rate for Payer: EPIC Health Plan Commercial |
$2,826.90
|
| Rate for Payer: Heritage Provider Network Commercial |
$3,544.10
|
| Rate for Payer: Heritage Provider Network Senior |
$3,544.10
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.54
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.75
|
| Rate for Payer: Multiplan Commercial |
$3,926.25
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,908.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,749.01
|
|
|
HC THYROGEN 1.1MG
|
Facility
|
OP
|
$5,235.00
|
|
|
Service Code
|
CPT J3240
|
| Hospital Charge Code |
909301498
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$947.54 |
| Max. Negotiated Rate |
$4,965.25 |
| Rate for Payer: Adventist Health Commercial |
$1,047.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$4,965.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$3,596.44
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$2,526.46
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$2,223.29
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$2,223.29
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$1,062.42
|
| Rate for Payer: Blue Shield of California Commercial |
$1,873.90
|
| Rate for Payer: Blue Shield of California EPN |
$1,873.90
|
| Rate for Payer: Cash Price |
$2,355.75
|
| Rate for Payer: Cash Price |
$2,355.75
|
| Rate for Payer: Cigna of CA HMO/PPO |
$2,408.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$3,031.76
|
| Rate for Payer: Dignity Health Medi-Cal |
$2,223.29
|
| Rate for Payer: Dignity Health Senior |
$2,223.29
|
| Rate for Payer: EPIC Health Plan Commercial |
$3,350.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$2,021.17
|
| Rate for Payer: Heritage Provider Network Commercial |
$2,423.80
|
| Rate for Payer: Heritage Provider Network Senior |
$2,423.80
|
| Rate for Payer: Humana Medicare |
$2,021.17
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$3,159.98
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$2,021.17
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$3,840.22
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$947.54
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$2,384.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$1,308.75
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$2,546.67
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$2,546.67
|
| Rate for Payer: Multiplan Commercial |
$3,926.25
|
| Rate for Payer: TriValley Medical Group Commercial |
$2,094.00
|
| Rate for Payer: TriValley Medical Group Senior |
$2,094.00
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$1,908.68
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$1,749.01
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$3,031.76
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$2,223.29
|
| Rate for Payer: Vantage Medical Group Senior |
$2,021.17
|
|
|
HC THYROID BIOPSY PERCUTANEOUS
|
Facility
|
IP
|
$1,200.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
909000178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$217.20 |
| Max. Negotiated Rate |
$900.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.40
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$812.40
|
| Rate for Payer: Heritage Provider Network Senior |
$812.40
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.20
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
|
|
HC THYROID BIOPSY PERCUTANEOUS
|
Facility
|
OP
|
$1,200.00
|
|
|
Service Code
|
CPT 60100
|
| Hospital Charge Code |
909000178
|
|
Hospital Revenue Code
|
361
|
| Min. Negotiated Rate |
$83.05 |
| Max. Negotiated Rate |
$3,237.00 |
| Rate for Payer: Adventist Health Commercial |
$240.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$1,335.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$824.40
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$879.07
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$3,237.00
|
| Rate for Payer: Blue Shield of California Commercial |
$1,086.22
|
| Rate for Payer: Blue Shield of California EPN |
$933.56
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cash Price |
$540.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$780.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Dignity Health Medi-Cal |
$966.98
|
| Rate for Payer: Dignity Health Senior |
$879.07
|
| Rate for Payer: EPIC Health Plan Commercial |
$720.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$879.07
|
| Rate for Payer: Heritage Provider Network Commercial |
$742.80
|
| Rate for Payer: Heritage Provider Network Senior |
$1,081.26
|
| Rate for Payer: Humana Medicare |
$879.07
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$83.05
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$879.07
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$1,670.23
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$217.20
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$1,037.30
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$300.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$1,107.63
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$1,107.63
|
| Rate for Payer: Multiplan Commercial |
$900.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$966.98
|
| Rate for Payer: TriValley Medical Group Senior |
$966.98
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$2,600.00
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$2,188.00
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$1,318.60
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$966.98
|
| Rate for Payer: Vantage Medical Group Senior |
$879.07
|
|
|
HC THYROID HORMONE T3
|
Facility
|
IP
|
$260.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
900910827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$47.06 |
| Max. Negotiated Rate |
$195.00 |
| Rate for Payer: Adventist Health Commercial |
$52.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$178.62
|
| Rate for Payer: Cash Price |
$117.00
|
| Rate for Payer: Heritage Provider Network Commercial |
$176.02
|
| Rate for Payer: Heritage Provider Network Senior |
$176.02
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$47.06
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$65.00
|
| Rate for Payer: Multiplan Commercial |
$195.00
|
|
|
HC THYROID HORMONE T3
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
CPT 84480
|
| Hospital Charge Code |
900910827
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$9.77 |
| Max. Negotiated Rate |
$118.62 |
| Rate for Payer: Adventist Health Commercial |
$10.80
|
| Rate for Payer: Aetna of CA Gatekeeper |
$41.25
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$37.10
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$14.18
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$118.62
|
| Rate for Payer: Blue Shield of California Commercial |
$110.74
|
| Rate for Payer: Blue Shield of California EPN |
$86.57
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna of CA HMO/PPO |
$35.10
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$21.27
|
| Rate for Payer: Dignity Health Medi-Cal |
$15.60
|
| Rate for Payer: Dignity Health Senior |
$14.18
|
| Rate for Payer: EPIC Health Plan Commercial |
$35.10
|
| Rate for Payer: EPIC Health Plan Medicare |
$14.18
|
| Rate for Payer: Heritage Provider Network Commercial |
$33.43
|
| Rate for Payer: Heritage Provider Network Senior |
$33.43
|
| Rate for Payer: Humana Medicare |
$14.18
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$19.64
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$14.18
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$26.94
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$9.77
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$16.73
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$13.50
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$17.87
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$17.87
|
| Rate for Payer: Multiplan Commercial |
$40.50
|
| Rate for Payer: TriValley Medical Group Commercial |
$14.18
|
| Rate for Payer: TriValley Medical Group Senior |
$14.18
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$15.31
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$15.31
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$21.27
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$15.60
|
| Rate for Payer: Vantage Medical Group Senior |
$14.18
|
|
|
HC THYROID SCAN
|
Facility
|
IP
|
$1,425.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
909301316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.92 |
| Max. Negotiated Rate |
$1,068.75 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.98
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Heritage Provider Network Commercial |
$964.72
|
| Rate for Payer: Heritage Provider Network Senior |
$964.72
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.92
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
|
|
HC THYROID SCAN
|
Facility
|
OP
|
$1,425.00
|
|
|
Service Code
|
CPT 78013
|
| Hospital Charge Code |
909301316
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$257.92 |
| Max. Negotiated Rate |
$1,110.20 |
| Rate for Payer: Adventist Health Commercial |
$285.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$335.83
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$978.98
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,110.20
|
| Rate for Payer: Blue Shield of California EPN |
$631.34
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cash Price |
$641.25
|
| Rate for Payer: Cigna of CA HMO/PPO |
$926.25
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$926.25
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$882.08
|
| Rate for Payer: Heritage Provider Network Senior |
$882.08
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$271.50
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$257.92
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$356.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,068.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC THYROID UPTAKE MULT
|
Facility
|
OP
|
$953.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$165.23 |
| Max. Negotiated Rate |
$979.11 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Aetna of CA Gatekeeper |
$165.23
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.71
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$426.95
|
| Rate for Payer: Blue Shield of California EPN |
$242.79
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Cigna of CA HMO/PPO |
$619.45
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$619.45
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$589.91
|
| Rate for Payer: Heritage Provider Network Senior |
$589.91
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.49
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.25
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$714.75
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC THYROID UPTAKE MULT
|
Facility
|
IP
|
$953.00
|
|
|
Service Code
|
CPT 78012
|
| Hospital Charge Code |
909301311
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$172.49 |
| Max. Negotiated Rate |
$714.75 |
| Rate for Payer: Adventist Health Commercial |
$190.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$654.71
|
| Rate for Payer: Cash Price |
$428.85
|
| Rate for Payer: Heritage Provider Network Commercial |
$645.18
|
| Rate for Payer: Heritage Provider Network Senior |
$645.18
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$172.49
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$238.25
|
| Rate for Payer: Multiplan Commercial |
$714.75
|
|
|
HC THYROID UPTAKE/SCAN
|
Facility
|
OP
|
$1,736.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$314.22 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Adventist Health Commercial |
$347.20
|
| Rate for Payer: Aetna of CA Gatekeeper |
$489.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,192.63
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$515.32
|
| Rate for Payer: Blue Shield of California Commercial |
$1,267.10
|
| Rate for Payer: Blue Shield of California EPN |
$720.56
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Cigna of CA HMO/PPO |
$1,128.40
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$772.98
|
| Rate for Payer: Dignity Health Medi-Cal |
$566.85
|
| Rate for Payer: Dignity Health Senior |
$515.32
|
| Rate for Payer: EPIC Health Plan Commercial |
$1,128.40
|
| Rate for Payer: EPIC Health Plan Medicare |
$515.32
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,074.58
|
| Rate for Payer: Heritage Provider Network Senior |
$1,074.58
|
| Rate for Payer: Humana Medicare |
$515.32
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$333.06
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$515.32
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$979.11
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.22
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$608.08
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$649.30
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$649.30
|
| Rate for Payer: Multiplan Commercial |
$1,302.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$566.85
|
| Rate for Payer: TriValley Medical Group Senior |
$515.32
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$772.98
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$566.85
|
| Rate for Payer: Vantage Medical Group Senior |
$515.32
|
|
|
HC THYROID UPTAKE/SCAN
|
Facility
|
IP
|
$1,736.00
|
|
|
Service Code
|
CPT 78014
|
| Hospital Charge Code |
909301315
|
|
Hospital Revenue Code
|
341
|
| Min. Negotiated Rate |
$314.22 |
| Max. Negotiated Rate |
$1,302.00 |
| Rate for Payer: Adventist Health Commercial |
$347.20
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$1,192.63
|
| Rate for Payer: Cash Price |
$781.20
|
| Rate for Payer: Heritage Provider Network Commercial |
$1,175.27
|
| Rate for Payer: Heritage Provider Network Senior |
$1,175.27
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$314.22
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$434.00
|
| Rate for Payer: Multiplan Commercial |
$1,302.00
|
|
|
HC THYROXIN T4
|
Facility
|
OP
|
$20.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$3.62 |
| Max. Negotiated Rate |
$57.53 |
| Rate for Payer: Adventist Health Commercial |
$4.00
|
| Rate for Payer: Aetna of CA Gatekeeper |
$19.99
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$13.74
|
| Rate for Payer: Alpha Care Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Alpha Care Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Alpha Care Medical Group Medicare Advantage/Dual Product |
$6.87
|
| Rate for Payer: Anthem Blue Cross of CA HMO/PPO |
$57.53
|
| Rate for Payer: Blue Shield of California Commercial |
$53.72
|
| Rate for Payer: Blue Shield of California EPN |
$42.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna of CA HMO/PPO |
$13.00
|
| Rate for Payer: Dignity Health Commercial/Exchange |
$10.30
|
| Rate for Payer: Dignity Health Medi-Cal |
$7.56
|
| Rate for Payer: Dignity Health Senior |
$6.87
|
| Rate for Payer: EPIC Health Plan Commercial |
$13.00
|
| Rate for Payer: EPIC Health Plan Medicare |
$6.87
|
| Rate for Payer: Heritage Provider Network Commercial |
$12.38
|
| Rate for Payer: Heritage Provider Network Senior |
$12.38
|
| Rate for Payer: Humana Medicare |
$6.87
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medi-Cal |
$8.08
|
| Rate for Payer: Inland Empire Health Plan (IEHP) Medicare Advantage |
$6.87
|
| Rate for Payer: Kaiser Permanente of CA Commercial |
$13.05
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$3.62
|
| Rate for Payer: Kaiser Permanente of CA Medicare Advantage |
$8.11
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$5.00
|
| Rate for Payer: Molina Healthcare of CA Medi-Cal |
$8.66
|
| Rate for Payer: Molina Healthcare of CA Medicare |
$8.66
|
| Rate for Payer: Multiplan Commercial |
$15.00
|
| Rate for Payer: TriValley Medical Group Commercial |
$6.87
|
| Rate for Payer: TriValley Medical Group Senior |
$6.87
|
| Rate for Payer: United Healthcare All Other HMO/non HMO |
$7.42
|
| Rate for Payer: United Healthcare Navigate/Select/Select+ |
$7.42
|
| Rate for Payer: Vantage Medical Group Commercial/Exchange |
$10.30
|
| Rate for Payer: Vantage Medical Group Medi-Cal |
$7.56
|
| Rate for Payer: Vantage Medical Group Senior |
$6.87
|
|
|
HC THYROXIN T4
|
Facility
|
IP
|
$138.00
|
|
|
Service Code
|
CPT 84436
|
| Hospital Charge Code |
900910835
|
|
Hospital Revenue Code
|
301
|
| Min. Negotiated Rate |
$24.98 |
| Max. Negotiated Rate |
$103.50 |
| Rate for Payer: Adventist Health Commercial |
$27.60
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$94.81
|
| Rate for Payer: Cash Price |
$62.10
|
| Rate for Payer: Heritage Provider Network Commercial |
$93.43
|
| Rate for Payer: Heritage Provider Network Senior |
$93.43
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$24.98
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$34.50
|
| Rate for Payer: Multiplan Commercial |
$103.50
|
|
|
HC TIBIA FIBULA
|
Facility
|
IP
|
$529.00
|
|
|
Service Code
|
CPT 73590
|
| Hospital Charge Code |
909001638
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$95.75 |
| Max. Negotiated Rate |
$396.75 |
| Rate for Payer: Adventist Health Commercial |
$105.80
|
| Rate for Payer: Aetna of CA Non-Gatekeeper |
$363.42
|
| Rate for Payer: Cash Price |
$238.05
|
| Rate for Payer: Heritage Provider Network Commercial |
$358.13
|
| Rate for Payer: Heritage Provider Network Senior |
$358.13
|
| Rate for Payer: Kaiser Permanente of CA Medi-Cal |
$95.75
|
| Rate for Payer: LLUH Dept of Risk Management WC |
$132.25
|
| Rate for Payer: Multiplan Commercial |
$396.75
|
|
